This kind of care is classified into three levels (by the Intensive Care Society):
- Level 1: Patients at risk of their condition deteriorating,or those recently relocated from higher levels of care whose needs can be met on an acute ward with additional advice and support from the critical care team
- Level 2: Patients requiring more detailed observation or intervention including support for a single failing organ system or postoperative care, and those stepping down from higher levels of care
- Level 3: Patients needing monitoring and support for two or more organ systems one of which may be basic or advanced respiratory support.
Nurses working in critical care have specific skills, knowledge and competencies to look after critically ill patients and part of that role is continuous observation of patients. Close monitoring and observations can reduce a patient's risk of deterioration and further complications.
The Department of Health believes that current arrangements to identify all the hospital patients that require critical care, especially those in general wards, are inadequate. It has been trying to modernise critical care services since 2000 and increase capacity.
Its Adult Critical Care Stakeholder Forum was established in 2004 to mobilise all interested parties in improving critical care services and to provide a communications link between various professional, operational and managerial groups delivering critical care.
The Stakeholder Forum says critical care needs to be viewed as a whole system, including dedicated critical care units, but also resources to support at-risk patients on general wards, and services supporting rehabilitation of patients recovering from critical illness in the hospital and in primary care.
The ideal effective critical care service, it believes, should include 24/7 outreach services, provision for comprehensive rehabilitation, good transfer and transport arrangements, and 24/7 support services.
Such a good service is reliant on an appropriately skilled workforce, so there is a need to review the numbers and skills of staff caring for critically ill patients in all settings. The issue of appropriate nurse staffing levels for intensive care units has been debated in the past few years, although everyone seems to agree that adequate training must be provided, roles redesigned and new roles developed.
The need for critical care outreach services has been known for some time and is a way of improving patient outcomes by identifying signs that a patient is deteriorating and acting on it before that patient has to be admitted to a critical care area.
Updated: September 2006